B. L. Corey1,2, L. Goss1,2, A. Gullick1,2, M. Morris1,2, D. Chu1,2, J. Grams1,2 1University Of Alabama At Birmingham,Surgery,Birmingham, ALABAMA, USA 2Birmingham Veteran’s Affairs Medical Center,Surgery,Birmingham, ALABAMA, USA
Introduction: Emergent operations for diverticular disease are associated with worse clinical outcomes. Understanding predictors of emergency surgery may help guide recommendations for elective operations. We hypothesized that patient-specific factors, such as co-morbid conditions, would predict emergent operation in the surgical treatment of diverticulitis.
Methods: The 2012-2013 national surgical quality improvement (NSQIP) patient database was queried for patients undergoing surgical management for diverticulitis. Patients were stratified by emergent versus non-emergent operations. Univariate analyses were used to determine predictors of emergent versus non-emergent operations. Multivariate adjustments were made using logistic regression utilizing stepwise selection of all possible covariates. Significance was determined as p-value ≤0.05.
Results: Of 8,070 patients who underwent surgery for diverticulitis, median age was 59 years and patients were more commonly female (54.2%), white (93%), and non-smoking (78.5%). Of these, 84.2% of cases were non-emergent and 15.8% were emergent. When compared to non-emergent patients, emergent patients were older (64 vs 59 years, p=<0.001) and had a higher incidence of diabetes (13.1 vs 10.2%, p=0.003), COPD (9.9 vs 3.8%, p<0.001), hypertension (54.3 vs 46.9%, <0.001), steroid use (14.1 vs 4.5%, p=<0.001), and severe or life-threatening ASA class (71.4 vs 37.4%, p<0.001). On multivariate analysis, independent predictors of emergency operation included male sex (odds ratio [OR]1.3), steroid use (OR 1.75), and higher ASA Class (ASA class 3, OR 2.7; ASA class 4-5, OR 17.7) (p<0.05).
Conclusion: Patients of male sex, with steroid use, and higher ASA class were at increased risk of an emergency operation. These factors should be considered when recommending surgery for patients with diverticulitis.